Provider Demographics
NPI:1154324028
Name:MACORETTA, KARMELL J (NP)
Entity Type:Individual
Prefix:MRS
First Name:KARMELL
Middle Name:J
Last Name:MACORETTA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 HARRIS HILL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7472
Mailing Address - Country:US
Mailing Address - Phone:716-204-0777
Mailing Address - Fax:716-204-0774
Practice Address - Street 1:342 HARRIS HILL RD
Practice Address - Street 2:STE 5
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7472
Practice Address - Country:US
Practice Address - Phone:716-204-0777
Practice Address - Fax:716-204-0774
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303928363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026585601OtherUNIVERA
NY02499521Medicaid
NY9512183OtherINDEPENDENT HEALTH
NY000560843001OtherBLUE CROSS BLUE SHIELD
NY00026585601OtherUNIVERA
NYRA1298Medicare ID - Type Unspecified